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Why Won't My Ankle Sprain Heal?

Suneel K. Basra, DPM, FACFAS
Foot & Ankle Surgeon from New Jersey

As foot and ankle surgeons, we see it happen all the time—one minute a person is walking, the next, they misstep and “twist” their ankle, landing them on the ground and eventually into our offices. Sprained ankles are painful and can temporarily limit a patient’s ability to walk normally, but properly diagnosing and treating an ankle injury in a timely manner is imperative to proper healing and reduces the chances of long-term, chronic ankle pain.

I often hear the misconception from people that, “it’s just a sprain, no big deal,” but sometimes a sprain can be or become more of an issue. Upon examination and after diagnostic tests, such as x-rays and even possibly an MRI, ankle sprains are graded based on severity and location of the injury to the ankle structures. Grade one is least severe—an injury to the outer ankle ligament only. Grade two is an injury to both outer and inner ligaments. Grade three is what is known as a “high ankle sprain”—an injury to the ligament connecting the shin bone to the outer bone of the leg.  

Severity of the injury comes into play as well. Foot and ankle surgeons determine if the ligament is partially or fully torn or overstretched, and we also look to identify how much swelling is going on. Is there a broken bone or a dislocation of the joint? These factors play a role in how we aim to treat the injury and how long the recovery will last.

A bone fracture typically takes six to eight weeks to heal, while a ligament sprain can take between three and six months to heal. The time difference in healing a bone versus a ligament is all about blood flow. The bone has better access to blood, whereas unfortunately, ligaments do not.

Most ankle injuries—roughly 80 percent of cases—require no surgical intervention. Foot and ankle surgeons will always choose the most conservative treatment for the best long-term outcomes for a patient. If just the outer ligament is injured, we can typically reduce pain and swelling with a combination of ice, wraps and rest to lessen the chance of further tearing the ligament.

The other 20 percent of patients might have initially neglected their injury, and because they did not seek immediate care, what began as a grade one, may have turned into a more severe grade two or three injury, possibly requiring surgery.

Sprains not adequately rehabilitated, untreated or repeat injuries can cause chronic ankle instability—a condition marked by persistent discomfort and a giving way of the ankle from stretched or torn ligaments. Proper rehabilitation and treatment are needed to strengthen the muscles around the ankle and retrain the tissues within the ankle that affect balance to help prevent further sprains or injuries. Surgery is sometimes also needed depending on the degree of instability or the lack of response to nonsurgical approaches.

When asked “why my ankle sprain won’t heal,” the simple answer is this: it will heal. It takes time, patience and following your doctor’s instructions. The best thing a patient can do is to be seen by someone who specializes in foot and ankle care as soon as an injury occurs.

For more information on ankle sprains, other foot conditions, or to find a foot and ankle surgeon near you, visit FootHealthFacts.org—the American College of Foot and Ankle Surgeons’ patient education website.

Suneel K. Basra, DPM, FACFAS, is a foot and ankle surgeon from New Jersey. He is board certified in both foot surgery and reconstructive rearfoot and ankle surgery by the American Board of Foot and Ankle Surgery. Dr. Basra holds a podiatric medical degree from the New York College of Podiatric Medicine in New York City. He completed his residency as chief resident at New York Methodist Hospital in Brooklyn, NY. He is also a frequent lecturer and instructor.